混合型胆囊结石分型及与华支睾吸虫感染的关系

Association between Clonorchis sinensis infection and the subtypes of mixed gallbladder stones

目的对混合型胆囊结石进行系统性分型研究，探讨不同亚型的混合型胆囊结石与华支睾吸虫感染的关系。方法对2009年8月至2015年12月我院普外科诊治的349例混合型胆囊结石进行回顾性研究。采用红外光谱分析结石的物质成分，扫描电镜观察结石物质成分的分布情况及结石的微观结构，x一射线能谱仪分析结石的元素组成及分布情况，从而判断结石类型；采用研碎镜检法研究结石中华支睾吸虫卵检出情况，并根据患者的来源地（华支睾吸虫病高发区、低发区）、虫卵检出（阳性、阴性）将结石分组比较分析。结果共发现混合型结石14种亚型，分别是胆红素．碳酸钙混合型（n=134）、胆固醇一胆红素混合型（n=87）、胆红素一磷酸钙混合型（n=39）、胆固醇．碳酸钙混合型（n=30例）、胆固醇-胆红素一碳酸钙混合型（n=15）等。华支睾吸虫病高发区和华支睾吸虫卵阳性结石均以胆红素一碳酸钙混合型结石为主，低发区和虫卵阴性结石以胆固醇一胆红素混合型为主。华支睾吸虫病高发区与低发区结石类型差异有统计学意义（P〈0．05），虫卵阳性与阴性结石类型差异有统计学意义（P〈0．05）。结论混合型胆囊结石以胆红素．碳酸钙结石最多见，其次是胆固醇一胆红素混合型，华支睾吸虫感染与胆红素一碳酸钙混合型结石的关系更密切。

Objective A systematic study to classify mixed gallbladder stones to determine their re- lationship with Clonorchis sinensis infection. Methods 349 consecutive patients with mixed gallbladder stones were enrolled into this study and their gallstones were studied. The material composition of gallbladder stones was analyzed using Fourier Transform Infrared spectroscopy, and the distribution and microstructure of the material components were studied using Scanning Electron Microscopy. The composition and distribution of the elements were analyzed by an X-ray energy spectrometer. Gallbladder stones were classified according- ly, and the stones were then grinded for microscopic examination. The stones were divided into two groups based on the results of detection of clonorchis sinensis eggs. Patients were also divided into two groups ac- cording to the patientss region （high-incidence and low-incidence regions of Clonorchis sinensis infection）. The diversity of the subtypes of mixed gallbladder stones was compared. Results 14 subtypes were found, including Bilirubinate-calcium carbonate mixed stones （ n = 134 ） , Cholesterol-bilirubinate mixed stones （ n = 87）, Bilirubinate-phosphate mixed stones （ n = 39）, Cholesterol-calcium carbonate mixed stones （ n = 30）, Cholesterol-bilirubinate -calcium carbonate mixed stones （n = 15）, etc. Bilirubinate-calcium carbo- nate mixed stones were the main subtype of egg-positive mixed gallbladder stones and the patients were from high-incidence regions. Cholesterol-bilirubinate mixed stones were the main subtype of egg-negative mixed gallbladder stones and patients were from low-incidence regions. The differences of the subtypes constituent between the high-incidence and low-incidence regions groups were significant （P 〈 O. 05）, and between the egg-positive and egg-negative groups were also significant （ P 〈 0.05 ）. Conclusions The most common subtypes of mixed gallbladder stones were bilirubinate-calcium carbonate mixed stones, while the second was cholesterol-bilirubinate mixed stones. Clonorchis sinensis infection was mainly associated with Bilirubinate- calcium carbonate mixed stones.